Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine is an open accessed online journal and comprehensive peer-reviewed medical journal published by the Indonesian Society of Internal Medicine since 1968. Our main mission is to encourage the novel and important science in the clinical area in internal medicine.    We welcome authors for original articles (research), review articles, interesting case reports, special articles, clinical practices, and medical illustrations that focus on the clinical area of internal medicine.    Subjects suitable for publication include, but are not limited to the following fields of:    -Allergy and immunology  -Emergency medicine  -Cancer and stem cells  -Cardiovascular  -Endocrinology and Metabolism  -Gastroenterology  -Gerontology  -Hematology  -Hepatology  -Tropical and Infectious Disease  -Virology  -Internal medicine  -Psychosomatic  -Pulmonology  -Rheumatology  -Renal and Hypertension  -Thyroid

Acta Medica Indonesiana is an open-access online journal and a comprehensive peer-reviewed medical journal published by the Indonesian Society of Internal Medicine since 1968. Our main mission is to promote novel and significant scientific research in the clinical field of internal medicine. We welcome authors to submit original research articles, review articles, interesting case reports, special articles, clinical practices, and medical illustrations that focus on the clinical aspects of internal medicine. Suitable subjects for publication include, but are not limited to, the following fields: Allergy and Immunology, Emergency Medicine, Cancer and Stem Cells, Cardiovascular, Endocrinology and Metabolism, Gastroenterology, Gerontology, Hematology, Hepatology, Tropical and Infectious Diseases, Virology, Internal Medicine, Psychosomatic Medicine, Pulmonology, Rheumatology, Renal and Hypertension, and Thyroid.

《Acta Medica Indonesiana》是由印度尼西亚内科学会自1968年起出版的开放获取在线期刊，致力于全面的同行评审医学研究。我们的主要使命是促进内科学领域的新颖和重要科学研究。我们欢迎作者提交原创研究文章、综述文章、有趣的病例报告、特别文章、临床实践和医学插图，重点关注内科学的临床领域。适合发表的主题包括但不限于以下领域：过敏与免疫学、急救医学、癌症与干细胞、心血管、内分泌与代谢、胃肠病学、老年医学、血液学、肝病学、热带与传染病、病毒学、内科学、心理生理学、肺病学、风湿病学、肾脏与高血压、甲状腺。

Acta Medica Indonesiana

It has been known that the diagnosis of diabetes should be made early to prevent cardiovascular and other metabolic complications (such as malignancy, etc). So far, determination of blood glucose levels has been used to diagnose diabetes. As a matter of fact, some diabetic patients had already had chronic complication at the first time of diagnosis. It shows why the glucose-centric definition for diagnosing diabetes that has been used so far could not be applied to the sole diagnosis criteria for a group of patients with such “syndrome”. Blood glucose examination and the cut-off point for diagnosing diabetes have become controversial debates for a long time. In 1979, the National Diabetes Data Group (NDDG) made diagnostic criteria for diabetes, which subsequently have been used for over 2 decades. At that time, the Committee used the cut-off point of blood glucose level based on distribution and it was not associated with the correlation between blood glucose level and chronic complication. Diagnosis of diabetes was established when fasting plasma glucose level (FPG) >140 mg/dL; 2-hour post-prandial blood glucose or 2-hours PPG >200 mg/dL.1-5 In 1997, the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus reviewed the principles of diagnosis for diabetes. The Committee used the new approach for diagnosing diabetes by correlating the blood glucose level with the distribution of long-term complications. The Committee considered three epidemiological studies, i.e. the population study in Egypt (n=1018)6, US National Health and Nutrition Examination Survey (NHANES) survey (n=2821), PIMA Indians study with Hb A1c as diagnostic criteria (n=960).7 Those three studies used retinopathy complication as the dependent variable for determining the cut-off point of blood glucose level. By applying such approach, the criteria of diabetes has been changed, particularly from FPG >140 mg/dL into >126 mg/dL. The cut-off point may reveal more linearity association between FPG and PPG. In addition to establishing diagnosis criteria for diabetes, the Committee also introduced the terms “impaired fasting glucose” (IFG) and “impaired glucose tolerance” (IGT) to differentiate metabolic conditions between the normal groups and diabetics; with the criteria of 110-125 mg/dL and 140-199 mg/dL, respectively. Consequently, WHO adapted such approach and suggested individual with IFG should have oral glucose tolerance test (OGTT) to avoid the false-negative result and recommended OGTT as the gold standard for diagnosing diabetes. In 2003, the Committee revised the criteria from IFG >110 mg/dL into >100 mg/dL. However, WHO still used the criteria of 110 mg/dL for IFG. Since a long time ago, the experts have realized that determination of cut-off point for diagnosing diabetes will be revised over time with the lower blood glucose level as the more sensitive diagnosis for detecting the occurring complication.

Dante Saksono Harbuwono

Acta medica Indonesiana

Redefining diabetes: is it really necessary?

重新定义糖尿病：真的有必要吗？

Dendritic cells are major antigen-presenting cells (APC) that stimulate naA¯ve T cells, which induce adaptive immune responses. Gravesâ€™ disease (GD) is an autoimmune disease characterized by the presence of autoantibodies against Thyroid Stimulating Hormone Receptor (TSHR). The autoantibodies bind with TSHR and stimulate thyroid hormone production. Dendritic cells are still the major APC in GD immune response although thyrocytes in GD can also express Major Histocompatibility Class (MHC) class II molecule. Studies about DC in GD have been conducted by isolating intra-thyroid DC or DC in peripheral circulation. Results of DC studies in GD are still controversial. Changes in number and profile of DC are found, which indicate altered immune response activity and defects of regulator T cell (Treg) in GD. Key words : dendritic cells, Gravesâ€™ disease

Dyah Purnamasari

Pradana Soewondo

Samsuridjal Djauzi

Dendritic Cells in Gravesâ€™ Disease

Graves病中的树突状细胞

Nanang Soebijanto

Acta Med Indones

The difficulty of medical management of Cushing disease.

库欣病医疗管理的难度。

Aim : to compare the anti-malarial effect among sambiloto extract, chloroquine and artemisinin-only as well as those of their combination. Methods : the study was conducted in Central Biomedical Laboratory, Faculty of Medicine, Brawijaya University, Malang, Indonesia from January to February 2006. Malaria culture used Plasmodium falciparum of Papua strain (2300) that was obtained from Namru-2 Jakarta. Five drugs applied in this test; those were chloroquine, artemisinin, the extract of sambiloto, the combination of sambiloto and chloroquine, and the combination of sambiloto and artemisinin. Parasite density was determined by counting the number of Plasmodium falciparum infected erythrocyte in 5,000 erythrocytes of the culture. Single drug (Chloroquine-only or artemisinin only) and either combination with sambiloto at dose 0.5 ug/ml had killing-effect against the parasite, measured by the appearance of “crisis form” on the infected erythrocytes. This killing-effect was dose dependent, and reached its optimum effect of 200 ug/ml. Results : treatment of single sambiloto extract with dose 0.5 ug/ml increased the density of the parasite, however after every 1ug increasing dose of sambiloto extract, the killing effect also increased. The reduction of the parasite density was also seen by increasing the Sambiloto dose in the group of combination of sambiloto-chloroquine as well as the group of combination of sambiloto and artemisinin. Statistically, there was no difference in the anti-malaria efficacy among of five test drugs (p=1.00). The correlation between the reduction of the parasite with the increasing of dose in all groups is statistically significance (p=0.001). Conclusion : the extract of sambiloto in a single dose or in a combination evidently has the effect of anti-falciparum malaria. Key words : extract of sambiloto, antimalaria effect, in-vitro test.

Umar Zein

Loeki E Fitri

Awaluddin Saragih

Comparative study of antimalarial effect of sambiloto (Andrographis paniculata) extract, chloroquine and artemisinin and their combination against plasmodium falciparum in-vitro.

sambiloto（穿心莲）提取物、氯喹和青蒿素及其组合对恶性疟原虫体外抗疟效果的比较研究。

格雷夫斯病中的树突状细胞

Background: Prolonged pacing of the right ventricle (RV) is associated with left ventricular (LV) systolic dysfunction. Several studies have shown that the RV pacing location, pacing burden (percentage), and paced QRS duration may affect LV systolic function. Subclinical LV dysfunction may occur early after implantation of a permanent pacemaker (PPM). Therefore, this study aims to detect early subclinical LV systolic dysfunction measured by global longitudinal strain (GLS) using speckle tracking echocardiography (STE) at one month after PPM implantation. Methods: A single-center, prospective cohort study was conducted, and all patients indicated for PPM implantation with preserved LV systolic function were included. Data of RV pacing location (RV apical vs right ventricular outflow tract (RVOT), pacing burden (percentage) (≤40% vs >40%), and paced QRS duration (≤150 ms and >150 ms) were obtained. The change of GLS was also measured before and one month after PPM implantation (delta GLS). Results: 37 patients were enrolled in this study, which demonstrated significant difference between GLS before (-20.30 SD 3.38) and after (-16.93 SD 3.47) PPM implantation (p= 150ms ((1.70 (0.30–8.30) vs 3.45 (0.0–10.5)), p=0.266). Meanwhile, there was a significant difference of delta GLS between patients with pacing burden ≤40% vs >40% (Mean 1.92 SD 1.37 vs 3.98 SD 3.04), p=0.007). Further analysis found that pacing burden only affected the delta GLS in group with apical RV pacing (≤40% (1.58 SD 0.59) vs > 40% (4.67 SD 3.47), p = 0.008) and did not affect the delta GLS in group with RVOT pacing (≤40% (2.32 SD 1.98) vs > 40% (3.29 SD 2.48), p = 0.446). Conclusion: The pacing parameter, particularly pacing burden > 40% may induce the subclinical LV systolic dysfunction after one month of pacemaker implantation as shown by decline of GLS,  especially when the RV pacing location was placed on apical.

Mohammad Iqbal

Gadih Ranti Endamatriza

Irene Lampita

Sindy Hendrawansyah

Sidhi Laksono

Melawati Hasan

Chaerul Achmad

Giky Karwiky

Hanna Goenawan

Mohammad Rizki Akbar

Arief Sjamsulaksan Kartasasmita

The Influence of Right Ventricular Pacing Location, Pacing Burden and Paced QRS Duration to Subclinical Left Ventricular Systolic Dysfunction as Shown by Global Longitudinal Strain Echocardiography.

右心室起搏位置、起搏负荷及起搏QRS时限对亚临床左心室收缩功能障碍的影响——基于整体纵向应变超声心动图的研究

Background: Point-of-care ultrasound (POCUS) is increasingly used in internal medicine   field. Ultrasound training has been part of the training provided in the Internal Medicine Residency Program (IMRP). The aim of this study is to examine the residents’ needs and perceptions regarding their competency and needs of POCUS. Methods: We conducted a cross-sectional descriptive study using secondary data from a survey  among internal medicine residents at the Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital. The survey was conducted to evaluate and improve the curriculum in IMRP. Results: A total of 175 out of 197 residents (88.8%) completed the questionnaire. Almost all the residents (99.4%) agreed that POCUS is a beneficial must-have skill during residency. Nevertheless, only 40% of residents identified themselves as competent in POCUS. Sixty-two percent residents reckoned that the training received during the residency program is insufficient. They indicated that the most useful skills are US of hepatobiliary, lungs, heart, kidneys, and US-guided procedures. Conclusion: This study confirms that there is a need for POCUS training for   IM residents, as the majority perceived themselves as unable to perform US. It is necessary to optimize the training provided to ensure proficiency.

Martha Rosana

Oke Dimas Asmara

Rabbinu Rangga Pribadi

Kemal Fariz Kalista

Kuntjoro Harimurti

Internal Medicine Residents’ Perceptions of Point-of-Care Ultrasound in Residency Program: Highlighting the Unmet Needs

住院医师对住院医师项目中即时超声的认知：强调未满足的需求

The use of pacemakers is necessary for patients with symptomatic bradycardia. Pacemaker implantation also acts as a life-saving procedure. However, there are several reports that patients with a pacemaker (the most widely used pacemaker is on the right ventricle, known as single chamber pacemaker) had disturbances in left ventricle contraction lead to left ventricular systolic dysfunction. Global Longitudinal Strain (GLS) Echocardiography can confirm these left ventricular disturbances. Echocardiography examination is best carried out before and after single-chamber PPM implantation. This study compares PPM placement in apical Right Ventricle (RV) and Right Ventricular Outflow Tract (RVOT) and compares paced QRS duration 150 ms and > 150 ms. Pacing burden >40% causes subclinical left ventricular systolic dysfunction after a month of PPM implantation with decreased GLS in apical RV pacing.This study gives additional information that PPM placement is preferably in RVOT with some specific settings. However, there are many ways to reduce the effects of impaired left ventricular function due to lead installation on the PPM single-chamber device. By using the PPM device which has a dual chamber, the leads will be placed in RVOT and also in the right atrium with atrial-ventricle synchronization. The aim is to avoid impaired left ventricular pump function as supported by a systematic review which states the superiority of dual-chamber PPM over single-chamber PPM in reducing atrial fibrillation and pacemaker syndrome. In the importance of quality of life related to heart disease, the Indonesian version of the MacNew questionnaire can be used. This questionnaire seeks the quality of life of patients with coronary heart disease after revascularization surgery and has undergone rehabilitation. Another important thing is the suitability of the adaptation to the original English version.

Ika Prasetya Wijaya

The Importance of Selecting Permanent Pacemaker, Evaluating the Heart and Assessing Quality of Life in Cardiac Patient.

心脏患者选择永久起搏器、评估心脏及生活质量的重要性。

COVID-19 is a disease reported to suppress cellular immunity. This may lead to the development of opportunistic infections, among others black fungus, or mucormycosis. On the other hand, pre-existing defect in immunity may render patients susceptible to both mucormycosis and COVID-19. Mucormycosis is a relatively rare fungal infection with rapid progression unless diagnosed promptly and treated adequately, and urgent surgical and medical intervention is lifesaving. The manifestation of mucormycosis largely depends on the presence of exposure to the pathogen and the existing risk factor of the host. As black fungus is locally invasive, the majority of cases will involve tissue damage with local destruction and contiguous spread to nearby structure. We here with present a case of black fungus complicated with COVID-19 in a man with underlying non-Hodgkin's lymphoma.

Erni J Nelwan

Rahajeng N Tunjungputri

Retno S Wardani

Retno Wahyuningsih

Black Fungus Complicated with COVID-19 in a Man with Underlying Non-Hodgkin's Lymphoma

伴有基础非霍奇金淋巴瘤的COVID-19患者并发黑木耳感染

Coronavirus disease (COVID-19) infection attacks the mucosal structures of the respiratory tract, especially the bronchial mucosa and immune cells. The skin changes and manifestations related to COVID-19 infection remain not clearly understood. Cutaneous manifestations related to COVID-19 had been reported. Our patient manifested atypical cutaneous exanthem on her legs, with no other abnormalities found. We used oral azithromycin 500 mg, dexamethasone 0.5 mg, vitamin C 100 mg, and paracetamol 500 mg, which are available at Badak Baru Primary Health Care. The exanthem has improved after 10 days of treatment.

Prasetyadi Mawardi

Danu Yuliarta

Waode Nuraida

Atypical Exanthem as Cutaneous Manifestation Related to COVID-19 at a Primary Healthcare Facility

以初级保健机构为背景的COVID-19相关皮肤表现的非典型皮疹

Abbreviation	Acta. Med. Indones.
Journal Impact	0.54
Quartiles(Global)	MEDICINE, GENERAL & INTERNAL(Q3)

ISSN	0125-9326, 2338-2732
h-index	34

Publication Information	Publisher: Indonesian Society of Internal Medicine，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2004，Proportion of original research papers: 85.51%，Self Citation Rate:0.00%， Gold OA Rate: 0.00%
Journal Fees	$500Details
Average review cycle	网友分享经验：12 Weeks

Acta Medica Indonesiana

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Redefining diabetes: is it really necessary?

Dendritic Cells in Gravesâ€™ Disease

The difficulty of medical management of Cushing disease.

Comparative study of antimalarial effect of sambiloto (Andrographis paniculata) extract, chloroquine and artemisinin and their combination against plasmodium falciparum in-vitro.

Dendritic Cells in Gravesâ€™ Disease

The Influence of Right Ventricular Pacing Location, Pacing Burden and Paced QRS Duration to Subclinical Left Ventricular Systolic Dysfunction as Shown by Global Longitudinal Strain Echocardiography.

Internal Medicine Residents’ Perceptions of Point-of-Care Ultrasound in Residency Program: Highlighting the Unmet Needs

The Importance of Selecting Permanent Pacemaker, Evaluating the Heart and Assessing Quality of Life in Cardiac Patient.

Black Fungus Complicated with COVID-19 in a Man with Underlying Non-Hodgkin's Lymphoma

Atypical Exanthem as Cutaneous Manifestation Related to COVID-19 at a Primary Healthcare Facility